Provider Demographics
NPI:1831673763
Name:GOLDEN PEAK RECOVERY
Entity Type:Organization
Organization Name:GOLDEN PEAK RECOVERY
Other - Org Name:GOLDEN PEAK RECOVERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-694-8619
Mailing Address - Street 1:1515 NW 167TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5106
Mailing Address - Country:US
Mailing Address - Phone:786-923-3376
Mailing Address - Fax:786-930-7437
Practice Address - Street 1:4411 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2009
Practice Address - Country:US
Practice Address - Phone:855-694-8619
Practice Address - Fax:305-930-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2080-01OtherCOLORADO DEPARTMENT OF HUMAN SERVICES